Conflict management: difficult conversations with difficult people

Conflict Competence Among Resident Physicians: Knowledge and Perception

BACKGROUND

The hospital environment is a complex and unpredictable workplace where different providers share the responsibility of patient care. Differences in opinions, values, and experiences between resident physicians and other care team members may trigger conflicts that affect the safety and quality of patient care. Thus, developing conflict competencies may help to negotiate the complexities of different conflict situations and resolve these conflicts. However, the extent of the knowledge and perception of conflict competence among resident physicians remains to be determined.

METHODS

A survey and qualitative semi-structured interviews of resident physicians were conducted. Participants were recruited voluntarily. Survey results were analyzed using SPSS 21, and MAXQDA 24 was used to evaluate the interview transcripts with thematic analysis.

RESULTS

Sixty-five resident physicians completed the survey, and 15 resident physicians were interviewed. 61.5% of the survey respondents identified as female, 76.9% were Caucasian, 35.4% of the respondents were from surgical specialties, and 43.1% of the residents were in their second year of training. 53.8% of the participants reported witnessing or experiencing conflicts weekly, with 44.6% reporting resident physician-nurse conflicts. 63.1% of the conflicts were reported as unresolved, with 16.9% reporting that the conflict affected future working relationships, 25.5% of the conflicts were due to failure of communication, 75.4%residents did not have any form of prior training on conflict management, and 83.1% of them reported interest in conflict competence training. Conflicts mainly affected the quality of care (87.3%) compared to patient safety concerns (12.3%). Participants with prior training in conflict competence were more likely to resolve their reported conflict (p = 0.047). The interviews highlighted 5 main themes: sources of conflict, awareness of conflict resolution styles, addressing conflict and outcomes, and the effect on patient care. Sources of conflict included hierarchy and different priorities. 52.2% of the respondents did not know any style of conflict resolution. Addressing conflict included collaboration, avoidance, competition, and prevention. Avoidance was the most common style used by interviewees, followed by collaboration. While most felt that the conflicts affected the quality of patient care, 1 interviewee reported severe adverse events on the patient.

CONCLUSION

Conflicts are rife in the hospital environment and can affect patient care when unresolved. Resident physicians' knowledge of conflict competence is low and does not reflect the complexity of their working environment. Future training in conflict competence and resolution is warranted.

Perceived competences, attitudes, and training needs in conflict management among a cohort of Italian physiotherapists: A cross-sectional survey study

Conflict management is rarely explored among physiotherapists though they often work in teams. Hence, this study explored attitudes, perceived competencies, beliefs, training experiences, and needs in conflict management among Italian physiotherapists. We conducted a cross-sectional online survey study between June and September 2023 among Italian physiotherapists. The survey instrument comprised four sections. Section 1: Socio-Demographic and Professional Data: Explored participant profiles and conflict frequency. Section 2: Attitudes and Competences: assess conflict-related behaviours and management styles (Likert Scale). Section 3: Training Experiences and Needs: Evaluated training importance and conflict-related issues with other professionals (Likert Scale). Section 4: Beliefs About Factors: Participants rated (0-10) factors influencing conflict management and its impact on care and well-being. Descriptive analyses were performed, presenting continuous data as mean (SD) and categorical data as frequencies/percentages. Likert scale responses were dichotomised (agreement/disagreement), and consensus was defined as ≥70% agreement. Median, quartiles, and box-and-whisker plots depicted responses were used for 0-to-10 scales. Physiotherapists (n = 203; mean age: 39±10.40) generally leaned towards a constructive communication style, characterised by compromise and collaboration, viewing conflict management as an opportunity to grow. There was a disparity between their exhibited behaviours and self-assessment of appropriateness in conflict resolution. Only 27.6% considered their conflict resolution skills as satisfactory. However, 85.7% acknowledged the significance of being trained in conflict management. Challenges were evident in conflicts within interprofessional relationships and communication with superiors. Both personal and organisational factors were identified as influencing conflict management, with participants recognising the detrimental impact of conflicts on their well-being and patient care. This study highlighted educational gaps in conflict management among Italian physiotherapists, showing areas of improvement in their training. Our results suggested that physiotherapists might need additional training in conflict management to enhance workplace well-being and the quality of care provided.

Nursing faculty members' response to bullying in the eyes of their students: A pilot study in Pangasinan

BACKGROUND

Bullying is a pervasive issue that can occur in any setting, including among nursing students and within the nursing profession. Faculty members have a vital role in resolving bullying.

OBJECTIVES

To examine the nursing faculty members' responses to incidents of bullying within two nursing institutions in Pangasinan.

DESIGN

Descriptive- comparative design.

SETTINGS

Two Colleges of Nursing in a city in Pangasinan, Philippines.

PARTICIPANTS

Nursing students from first to fourth year BS Nursing students.

METHODS

An online survey was the main tool in this study, Lynch formula was utilized to calculate the sample size. There are 458 nursing students who participated in this study. Frequency, percentage, mean, standard deviation, one-way ANOVA, and t-test were used to analyze the data.

RESULTS

It was revealed that faculty members sometimes address bullying by group discussion (M = 3.26, SD = 1.27), and they almost never utilized non-intervention in bullying (M = 2.33, SD = 0.85). There is a variation in terms of group discussion with a one-way ANOVA score of F (2, 455) = 3.22, p = 0.04, when faculty members are grouped according to their degrees. Regarding the difference between the faculty members' responses to bullying when grouped according to gender, there is a significant difference between male and female for mediation (t(457) = 2.10, p = 0.04), group discussion (t(457) = 2.79, p = 0.01), victim support (t(457) = 2.54, p = 0.01), and disciplinary methods (t(457) = 2.66, p = 0.01).

CONCLUSION

The study emphasizes the complex nature of tackling bullying among nursing students. It highlights the efficacy of several solutions used by faculty members, such as group discussions, mediation, victim assistance, and disciplinary measures. The findings indicate that a comprehensive understanding of the dynamics involved in addressing bullying is necessary. This understanding highlights the significance of a cooperative and compassionate strategy that includes all individuals involved in the educational setting. It is clear that a standardized approach may not be enough, and customized techniques that take into account the particular circumstances and requirements of the persons involved are essential.

The structure and function of antagonistic ties in village social networks

Negative or antagonistic relationships are common in human social networks, but they are less often studied than positive or friendly relationships. The existence of a capacity to have and to track antagonistic ties raises the possibility that they may serve a useful function in human groups. Here, we analyze empirical data gathered from 24,770 and 22,513 individuals in 176 rural villages in Honduras in two survey waves 2.5 y apart in order to evaluate the possible relevance of antagonistic relationships for broader network phenomena. We find that the small-world effect is more significant in a positive world with negative ties compared to an otherwise similar hypothetical positive world without them. Additionally, we observe that nodes with more negative ties tend to be located near network bridges, with lower clustering coefficients, higher betweenness centralities, and shorter average distances to other nodes in the network. Positive connections tend to have a more localized distribution, while negative connections are more globally dispersed within the networks. Analysis of the possible impact of such negative ties on dynamic processes reveals that, remarkably, negative connections can facilitate the dissemination of information (including novel information experimentally introduced into these villages) to the same degree as positive connections, and that they can also play a role in mitigating idea polarization within village networks. Antagonistic ties hold considerable importance in shaping the structure and function of social networks.

Employment of Small-Group Discussions to Ensure the Effective Delivery of Medical Education

The changing landscape of medical education has made small-group discussions crucial components. These sessions, including problem-based learning (PBL), case-based learning (CBL), and team-based learning (TBL), revolutionize learning by fostering active participation, critical thinking, and practical skills application. They bridge theory with practice, preparing future healthcare professionals for the dynamic challenges of modern healthcare. Despite their transformative potential, there are challenges in faculty preparation, resource allocation, and effective evaluation. The best practices include aligning discussions with curriculum goals, skilled facilitation, promoting active participation, and robust assessment strategies. Looking ahead, adapting to emerging health trends, ongoing research, and evolving healthcare demands will ensure the continued relevance and effectiveness of small-group discussions, shaping competent and adaptable healthcare providers equipped for the ever-evolving healthcare landscape.

Making the transition from student to newly qualified vascular sonographer: An exploration of the domains of professionalism

Introduction

Rapid increases in the utility of vascular ultrasound combined with increasing expectations from reporting physicians have required a shift to a more defined professional role for the vascular sonographer in Australia. This has created increasing pressure on newly qualified sonographers to be more job-ready and better able to navigate the challenges of the clinical workplace early in their career.

Topic Description

There is a distinct lack of structured strategies that newly qualified sonographers can utilise to assist their transition from student to employee. In our paper, we aimed to answer the question of 'What makes a sonographer a Professional?' with the view to extending understanding of how a structured framework can assist the development of a professional identity and can encourage participating in Continuing Professional Development by the newly qualified sonographer.

Discussion

The authors reviewed their own clinical experiences and the current literature to source tangible and practical strategies that can be easily enacted by newly qualified sonographers to motivate their continuing growth. Through this review, the 'Domains of Professionalism in the role of the sonographer' framework was developed. In this framework, we describe the various domains of professionalism and their associated dimensions, making it specific to the discipline of sonography and to the point of view of a newly qualified sonographer.

Conclusion

Our paper contributes to the discussion on Continuing Professional Development using a purposeful and targeted approach to support newly qualified sonographers across all discipline areas of ultrasound specialisation to navigate the often challenging pathway to becoming a professional.

Patient Safety/Quality Improvement Primer, Part IV: Psychological Safety-Drivers to Outcomes and Well-being

Psychological safety is the concept that an individual feels comfortable asking questions, voicing ideas or concerns, and taking risks without undue fear of humiliation or criticism. In health care, psychological safety is associated with improved patient safety outcomes, increased clinician engagement, and greater creativity. A culture of psychological safety is imperative for physician well-being and satisfaction, which in turn directly affect delivery of care. For health care professionals, psychological safety creates an environment conducive to trust and openness, enabling the team to focus on high-quality care. In contrast, unprofessional behavior reduces psychological safety and threatens the culture of the organization. This patient safety/quality improvement primer considers the barriers and facilitators to psychological safety in health care; outlines principles for creating a psychologically safe environment; and presents strategies for managing conflict, microaggressions, and lapses in professionalism. Individuals and organizations share the responsibility of promoting psychological safety through proactive policies, conflict management, interventions for microaggressions, and cultivation of emotional intelligence.

Changing the Landscape of Remediation: The Creation and Implementation of an Institution-Wide Graduate Medical Education Performance Enhancement Program

Purpose Remediation is a daunting process for both residency leadership and trainees due to several factors including limited time and resources, variable processes, and negative stigma. Our objective was to transform the remediation process by creating a transparent institution-wide program that collates tools/resources, interdepartmental faculty mentors, and positive rebranding. Methods Education leadership across seven specialties created a process for trainees with professionalism and interpersonal-communication skills deficiencies. Formalized departmental program-based improvement plan (PIP) and an institutional house staff performance enhancement plan (HPEP) were developed by consensus of triggers/behaviors. Utilizing published literature, a toolkit was created and implemented. Trainees were enrolled in HPEP if PIP was unsuccessful or exhibited ≥1 major trigger. Wellness evaluations were incorporated into the process to screen for external contributing factors. Surveys were sent to the program director (PD), faculty mentor, and trainee one month and six months after participation. Results Between 2018 and 2021, 12 trainees were enrolled. Overall feedback from PDs and the trainees was positive. The main challenge was finding mutual time for the faculty mentor and trainee to meet. Six-month surveys reported no relapses in unprofessionalism. One-year follow-up of the trainees was limited. Conclusions Utilizing an institution-wide standardized process of performance improvement with the removal of negative stereotyping is a unique approach to remediation. Initial feedback is promising, and future outcome data are necessary to assess the utility. The HPEP may be adopted by other academic institutions and may shift the attitudes about remediation and allow trainees to see the process as an opportunity for professional growth.

Research on the influence mechanism of university-enterprise collaboration: Evidence From five southern coastal provinces in China

Taking university-enterprise collaborative innovation in five southern coastal provinces of China as subjects, empirical research is implemented by constructing a theoretical model of the effects of interface resource integration, interface conflict management, interface connection mechanisms, and enterprise absorptive capacity on the university-enterprise collaborative innovation performance with the partial least squares structural equation modeling and fuzzy-set qualitative comparative analysis. A total of 245 valid questionnaires were collected from five coastal provinces in south China. The research results show that the interface resource integration, interface connection mechanisms, and enterprise absorptive capacity has direct significant positive impacts on the collaborative innovation performance. Interface conflict management has no significant impact on school-enterprise collaborative innovation performance. Moreover, the interface connection mechanism acts as an intermediary. Therefore, it is suggested that university-enterprise should integrate resources with complementing, interacting, and sharing resources; construct the profit and risk-sharing mechanism, communication and trust mechanism, and organizational learning mechanism.

Experiences of Work-Related Stress Among Female Healthcare Workers During the COVID-19 Public Health Emergency: A Qualitative Study in the United Arab of Emirates

Objective

Frontline healthcare workers experienced high levels of psychological distress and emotional turmoil due to the changes necessitated by the COVID-19 public health emergency. Given that workplace stress can negatively influence both quality of work, and job performance, this study sought to explore the lived experiences of work-related stress among female healthcare workers in United Arab of Emirates during the COVID-19 pandemic.

Methods

A qualitative phenomenological investigation was performed using a purposive sampling approach. A total of 26 semi-structured interviews were conducted with female healthcare workers who worked directly with COVID-19 patients. Using Giorgi's descriptive method, the data were analyzed to identify the main themes.

Results

Three main themes emerged from the data analysis, with nine categories under these themes. The first theme was "sources of work-related stress." The participants reported a high workload, fear of being infected and transmitting the virus to others, and uncertainty and lack of knowledge regarding COVID-19 to be the main sources of their work-related stress. The second theme was "challenges of working during the pandemic." The participants related being challenged by changes in the organization of care, the need to use personal protective equipment, a work-life imbalance, and witnessing patients' suffering. The third theme was "coping strategies." The participants perceived having sources of social support and using self-adjustment skills to be helpful strategies in terms of coping with the stressful situations they experienced.

Conclusion

The findings suggest a number of strategies and interventions that could be used at the individual and institutional levels to promote the preparedness and efficacy of healthcare workers during future crises and public health emergencies.

Research on the influence mechanism of university-enterprise collaboration: Evidence From five southern coastal provinces in China

Taking university-enterprise collaborative innovation in five southern coastal provinces of China as subjects, empirical research is implemented by constructing a theoretical model of the effects of interface resource integration, interface conflict management, interface connection mechanisms, and enterprise absorptive capacity on the university-enterprise collaborative innovation performance with the partial least squares structural equation modeling and fuzzy-set qualitative comparative analysis. A total of 245 valid questionnaires were collected from five coastal provinces in south China. The research results show that the interface resource integration, interface connection mechanisms, and enterprise absorptive capacity has direct significant positive impacts on the collaborative innovation performance. Interface conflict management has no significant impact on school-enterprise collaborative innovation performance. Moreover, the interface connection mechanism acts as an intermediary. Therefore, it is suggested that university-enterprise should integrate resources with complementing, interacting, and sharing resources; construct the profit and risk-sharing mechanism, communication and trust mechanism, and organizational learning mechanism.

The nature of conflict in community pharmacy - A pilot study of pharmacists' experiences during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has caused changes that disrupted the status quo of society. As a result, the level of conflict in community pharmacy has increased significantly. With existing conflict research more focused on the management of conflict, it is important to direct attention towards understanding the nature of conflict. This understanding will allow for informed resources to be developed to guide practice, decreasing the occurrence of and negative effects of conflict.

OBJECTIVE

This research explored experiences of pharmacists working in community pharmacies, to identify the occurrence and nature of conflicts which may have been motivated by changes resulting directly or indirectly from the COVID-19 pandemic, to provide directions for future research into the nature of conflict.

METHOD

Person-to-person semi-structured telephone interviews were conducted. Transcripts were analysed using inductive reasoning to identify themes.

RESULTS

Thirteen pharmacists agreed to participate in this study and 9 were interviewed. Analysis revealed 7 themes that described the causes, contributors, management, outcome, and essence of experienced conflict. A model that incorporated existing theory and themes derived from this study was developed to facilitate understanding of the nature of conflict in community pharmacy during the COVID-19 pandemic.

CONCLUSION

Conflict in community pharmacy settings follows a defined model with multiple interrelated themes. Guidance from this model may assist pharmacists in reducing occurrences of dysfunctional conflicts during their practice.

Managing Difficult Conversations: An Essential Communication Skill for All Professionals and Leaders

Managing difficult conversations is an important skill to develop and refine for all professionals and future leaders, particularly for those in health care where difficult situations with high stakes are prevalent. The intensity and frequency of these types of conversations will predictably increase as one's professional responsibility grows. In this article, the authors discuss their interprofessional course, Managing Difficult Conversations, developed 15 years ago for medical and graduate students at Stanford University. The course facilitates the practice of managing difficult conversations through role play in a low-risk, safe classroom setting among peers. The role-played difficult conversations are based upon a series of case studies and are facilitated by faculty and guest experts. There is no single communication style that suits everyone, but the authors offer resources from the course that can be applied for effective difficult conversations, including 12 guiding principles and a 3-stage framework for planning, beginning, and conducting the conversation. Preparing and practicing for difficult conversations will enhance the likelihood of conveying the necessary information with professionalism, directness, clarity, empathy, and warmth. Although unsettling news will always be difficult to receive, the method of delivery should be a source of comfort and hope, not one of discomfort and pain.

Use of clinical simulation to train healthcare teams in conflict management: A scoping review

OBJECTIVE

To assess and analyze the impact of clinical simulation as a training tool in healthcare teams ability to resolve and manage conflicts, through an exploratory systematic review.

METHODS

A structured literature review was performed with the terms [Clinical Simulation OR Patient Simulation OR Simulation Training OR High Fidelity simulation Training] AND [Conflict OR Conflict Resolution] in the following databases: MEDLINE, LILACS, Cochrane, Scielo, PubMed, CINHAL, ScienceDirect, MEDES, IBECS y DOCUMED. Articles were considered if they involved clinical simulation oriented to training of healthcare professionals or trainees in conflict management, using clinical scenarios, and excluding those studies older than 20 years. Absence of debriefing was not considered an exclusion criterion, neither the use of simulation along with other methodologies. A quantitative analysis was performed.

RESULTS

10 articles were retrieved, mostly with quasi-experimental designs, in which clinical simulation was designed as an interprofessional training and was used with multiple other methodologies like roleplay, reflexive practice and audiovisual aids, strategy that suggest an increase its effectivity. Different scenarios have been recreated, like decision-making divergences and management of medical errors, in order to apply the competences of mediation, communication, emotional skills among others, and followed by debriefing. The use of validated scales and conventional assessment methods reveal a positive impact on satisfaction, perception and learning of students, as well as transfer to clinical practice and decrease in errors.

CONCLUSION

Multiple studies describe and support the use of clinical simulation for training in management and resolution of conflicts among healthcare professionals. Simulation is accepted by participants, developing transfer of skills and competences and impact at the organizational level. Nonetheless, studies are recent and limited in number, making this area a developing field that promotes future research.

Improving breast cancer nurses' management of challenging situations involving family carers: Pilot evaluation of a brief targeted online education module (TRIO-Conflict)

OBJECTIVE

Given the stressful and emotional nature of cancer, challenging interactions between nurses, patients, and family frequently occur. Nurses are rarely equipped with strategies to avoid or de-escalate stressful situations with carers, which can include displays of conflict, anger, or dominance. A brief online education module (TRIO-Conflict) was developed to provide nurses with management strategies to use in situations of conflict. This study aimed to assess the feasibility, acceptability, and potential efficacy of TRIO-Conflict.

METHODS

Nurses were recruited through an Australian breast cancer organisation (McGrath Foundation). Participants completed pre/post module measures of attitudes towards carers, confidence in their skills to effectively navigate challenging interactions with carers, and applied knowledge of management strategies. Data were analysed using Wilcoxon signed-rank tests. Qualitative feedback was analysed using content analysis.

RESULTS

52 nurses completed pre-/post- measures, with 4 semi-structured interviews conducted. Significant improvements in attitudes towards carers (p = .010) and confidence in one's own ability to manage challenging interactions with carers (p < .001) were found, but not knowledge of strategies. Most nurses found TRIO-Conflict very/extremely helpful (87%) and were satisfied with content (94%) and usability (93%).

CONCLUSION

TRIO-Conflict utilised evidence-based learning techniques (provision of example phrases, video vignettes, reflective exercises) to improve nurses attitudes and confidence.

PRACTICE IMPLICATIONS

TRIO-Conflict is a brief, targeted, clinically relevant, and easily accessible online training programme which could be widely disseminated to oncology nurses.

Conflict situation in a suburban hospital, India: Reasons and measures to minimize

Health care has a prominent place in society and as a settingrequired to serve and care for its public and stimulate overallphysical, psychological, and social health. It has a distinctobligation to generate a healthy workplace. Conflict and diversityare intrinsic in health care, and conflict in interdisciplinaryteams is an accepted norm and unescapable. Thus, astudy was conducted to understand reasons for the conflictamongst varied levels of healthcare staff in a 150 bedded multispecialtyhospital in an Indian city. A Survey of 200 respondents(Healthcare and managerial staff) revealed that lack ofappreciation, job stress, and competition within the department(32%) were the major reasons for differences amongstthe employees. Concerning approaches adopted, compromisingand collaborating methods scored more (38% and38.6%, respectively). The results have shown that, in general,managers are familiar with conflict resolution techniques andbelieve in motivating their staff to increase their levels of performanceand retain them with the hospital. However, thereis a need to make the human resource system more robustand accommodating to ensure varied healthcare professionalsfrom different qualification backgrounds and job roles aretreated equitably

Workplace interpersonal conflict in prehospital emergency: Concept analysis

BACKGROUND

In the turbulent and stressful work environment of prehospital emergencies, the conflict among emergency medical technicians (EMT) and other health-care providers is inevitable. This study aims to examine the concept of workplace interpersonal conflict (WIC) in prehospital emergencies.

MATERIALS AND METHODS

The eight-step Walker and Avant's concept analysis approach was adopted to define the concept. Iranmedex, SID, Magiran, ISC, PubMed, Scopus, Embase, and Web of Science searched with keywords such as WIC and hospital emergencies. After an extensive review of online national and international databases, one dictionary, nine books, and 25 articles in English and Persian were retrieved for the purposes of the study.

RESULTS

The antecedents, attributes, and consequences of the concept identified. EMT must learn how to eliminate their destructive effects while enhancing constructive effects.

CONCLUSION

Conflict is an inevitable part of life, and EMT must learn how to reduce their destructive effects while increasing constructive results.

Use of clinical simulation to train healthcare teams in conflict management: a scoping review

OBJECTIVE

To assess and analyze the impact of clinical simulation as a training tool in healthcare teams ability to resolve and manage conflicts, through an exploratory systematic review.

METHODS

A structured literature review was performed with the terms clinical simulation OR patientsimulation OR simulation training OR high fidelity simulation training AND conflict OR conflict resolution in the following databases: MEDLINE, LILACS, Cochrane, Scielo, PubMed, CINHAL, ScienceDirect, MEDES, IBECS and DOCUMED. Articles were considered if they involved clinical simulation oriented to training of healthcare professionals or trainees in conflict management, using clinical scenarios, and excluding those studies older than 20 years. Absence of debriefing was not considered an exclusion criterion, neither the use of simulation along with other methodologies. A quantitative analysis was performed.

RESULTS

10 articles were retrieved, mostly with quasi-experimental designs, in which clinical simulation was designed as an interprofessional training and was used with multiple other methodologies like roleplay, reflexive practice and audiovisual aids, strategy that suggest an increase its effectivity. Different scenarios have been recreated, like decision-making divergences and management of medical errors, in order to apply the competences of mediation, communication, emotional skills among others, and followed by debriefing. The use of validated scales and conventional assessment methods reveal a positive impact on satisfaction, perception and learning of students, as well as transfer to clinical practice and decrease in errors.

CONCLUSION

Multiple studies describe and support the use of clinical simulation for training in management and resolution of conflicts among healthcare professionals. Simulation is accepted by participants, developing transfer of skills and competences and impact at the organizational level. Nonetheless, studies are recent and limited in number, making this area a developing field that promotes future research.

Best Practice in Supporting Professional Identity Formation: Use of a Professional Reasoning Framework

Professional identity and professionalism education are increasingly important to veterinary education, but many of the concepts remain intangible to veterinary students, and engagement is a persistent challenge. While whole-curriculum integration is recommended for a successful professional studies program, this is complicated by clinical faculty's discomfort with the content. Where professional studies education is centered around professional identity formation, a key element of this is the multi-perspective nature of veterinary work, with the veterinarian negotiating the needs of multiple stakeholders in animal care. Constructing teaching around a framework of professional reasoning, which incorporates the negotiation of different stakeholder needs, ethical decision making, communication, teamwork, and outcome monitoring, offers the potential to make professional identity a concept more visible to students in veterinary work, and guides students in the contextualization of taught material. A framework is presented for veterinary professional reasoning that signposts wider curriculum content and helps illustrate where material such as veterinary business studies, animal welfare, the human-animal bond, and professional responsibility, as well as attributes such as empathy and compassion, all integrate in the decisions and actions of the veterinary professional. The aims of this framework are to support students' engagement in professional studies teaching and help them use workplace learning experiences to construct an appropriate professional identity for competence and resilience in the clinic. For faculty involved in curriculum design and clinical teaching, the framework provides a tool to support the integration of professional identity concepts across the extended curriculum.

Assessment of third-year medical students' comfort and preparedness for navigating challenging clinical scenarios with patients, peers, and supervisors

BACKGROUND

Medical training focuses heavily on clinical skills but lacks in training for navigating challenging clinical scenarios especially with regard to diversity issues. Our objective was to assess third-year medical students' preparedness to navigate such scenarios.

METHODS

A 24-item survey was administered electronically to third-year medical students describing a range of specific interactions with patients, peers, and "upper-levels" or superiors including residents and attendings, spanning subjects including gender, race/ethnicity, politics, age, sexual orientation/identity, disability, and religion. Students rated their level of comfort via a 5-point Likert scale ranging from 1 ("Very Uncomfortable") to 5 ("Very Comfortable"). Basic demographics were collected and data were summarized for trends.

RESULTS

Data were analyzed from 120 students (67% response rate, 54.2% female, 60.8% non-Hispanic white). Students reported lower comfort with peer and superiors compared to patient interactions (p < 0.0001). Students reported the highest comfort with sexual orientation/identity- and religion-related interactions (median (IQR): 3.3 (1.3) and 3.4 (10.0), respectively) and the lowest comfort with gender-, race/ethnicity-, and disability- related interactions (median (IQR): 2.3 (1.3), 2.0 (1.0), 2.5 (1.5), respectively). Males reported significantly higher median comfort levels for scenarios with upper-level, gender, and religion related interactions. Males were more likely to be completely comfortable versus females across the 24 scenarios, although multiple male response patterns showed evidence of a bimodal distribution.

CONCLUSIONS

Third-year medical students report generally inadequate comfort with navigating complex clinical scenarios, particularly with peers and supervisors and relating to gender-, race/ethnicity-, and disability-specific conflicts. There are differences across gender with regards to median comfort and distribution of scores suggesting that there is a subgroup of males report high/very high comfort with challenging clinical scenarios. Students may benefit from enhanced training modules and personalized toolkits for navigating these scenarios.

Leadership for success in transforming medical abortion policy in Canada

Objectives

Mifepristone was approved for use in medical abortion by Health Canada in 2015. Approval was accompanied by regulations that prohibited pharmacist dispensing of the medication. Reproductive health advocates in Canada recognized this regulation would limit access to medical abortion and successfully worked to have this regulation removed in 2017. The purpose of this study was to assess the leadership involved in changing these regulations so that the success may be replicated by other groups advocating for health policy change.

Methods

This study involved a mixed methods instrumental design in the context of British Columbia, Canada. Our data collection included: a) interviews with seven key individuals, representing the organizations that worked in concert for change to Canadian mifepristone regulations, and b) document analysis of press articles, correspondence, briefing notes, and meeting minutes. We conducted a thematic analysis of transcripts of audio-recorded interviews. We identified strengths and weaknesses of the team dynamic using the Develop Coalitions, Achieve Results and Systems Transformation domains of the LEADS Framework.

Results

Our analysis of participant interviews indicates that autonomy, shared values, and clarity in communication were integral to the success of the group’s work. Analysis using the LEADS Framework showed that individuals possessed many of the capabilities identified as being necessary for successful health policy leadership. A lack of post-project assessment was identified as a possible limitation and could be incorporated in future work to strengthen dynamics especially when a desired outcome is not achieved. Document analysis provided a clear time-line of the work completed and suggested that strong communication between team members was another key to success.

Conclusions

The results of our analysis of the interviews and documents provide valuable insight into the workings of a successful group committed to a common goal. The existing collegial and trusting relationships between key stakeholders allowed for interdisciplinary collaboration, rapid mobilization, and identification of issues that facilitated successful Canadian global-first deregulation of mifepristone dispensing.

Health care risk managers' consensus on the management of inappropriate behaviors among hospital staff

Medical errors are the third-leading cause of death in the United States. One of the problems is timely recognition and management of inappropriate health care worker behaviors that lead to intimidation and loss of staff focus, eventually leading to errors. The purpose of this qualitative modified Delphi study was to seek consensus among a panel of experts in hospital risk management practices on the practical methods for early detection of inappropriate behaviors among hospital staff, which may be used by hospital managers to considerably mitigate the risk of medical mishaps. High reliability theory guided the research process, utilizing the conceptual framework of the fair and just culture patient safety model. A single research question asked what level of consensus exists among hospital risk management experts as to the practical methods for early detection of inappropriate behavior among hospital staff, which managers may use to ultimately mitigate the risk of preventable medical mishaps. This study included nonprobability purposive sampling (n = 34) and three rounds of questionnaires. Consensus was reached on 8 factors: setting expectations, developing a culture of respect, holding staff accountable, enforcing a zero-tolerance policy, confidentiality of reporting, communicating expected behavior, open communication, and investigating inappropriate behaviors.

Difficult debriefing situations: A toolbox for simulation educators

BACKGROUND

Simulation-based education (SBE) has emerged as an essential modality for health professions education. One of the central tenants of effective SBE is reflective practice, typically guided by a facilitated debriefing. The debriefing conversation has the possibility of becoming a difficult conversation based on learner and situation-related factors. Difficult debriefing situations may threaten the learning environment, thus requiring an appreciation and understanding of the various ways that learners may react adversely to simulation and debriefing.

AIM

This article provides a review of the various phenotypes of difficult debriefing situations and a toolbox of proactive and reactive strategies to help guide the simulation educator to manage these situations, with the ultimate goal of achieving learning objectives.

Effective followership: A standardized algorithm to resolve clinical conflicts and improve teamwork

In healthcare, the sustained presence of hierarchy between team members has been cited as a common contributor to communication breakdowns. Hierarchy serves to accentuate either actual or perceived chains of command, which may result in team members failing to challenge decisions made by leaders, despite concerns about adverse patient outcomes. While other tools suggest improved communication, none focus specifically on communication skills for team followers, nor do they provide techniques to immediately challenge authority and escalate assertiveness at a given moment in real time. This article presents data that show one such strategy, called the Effective Followership Algorithm, offering statistically significant improvements in team communication across the professional continuum from students and residents to experienced clinicians.